AB1205 MEDICAL AND PSYCHOLOGICAL COMORBIDITIES IN FIBROMYALGIA: A CROSS SECTIONAL STUDY
Authors: K. N. Thomas, A. Lawrence
Journal: Annals of the Rheumatic Diseases (2022)

Background Psychological disorders are commonly observed in fibromyalgia (FMS). Medical comorbidities are less well characterised in FMS. We sought to assess the prevalence of these disorders in an observational cohort of patients in a tertiary hospital in North India. Objectives The prevalence of medical and psychological comorbidities in FMS and the prevalence of these disorders in FMS subgroups classified according to different ACR classification criteria were assessed. Methods Patients satisfying either the 1990 ACR or the 2016 ACR Fibromyalgia criteria were included in a cross-sectional study between October’19 and December’21. All patients were assessed for prevalence of chronic fatigue syndrome (CFS), post-traumatic stress syndrome (PTSD), restless leg syndrome (RLS) and medical comorbidities including obesity, obstructive sleep apnoea, anemia, diabetes mellitus, hypertension and hypothyroidism. Results A total of 98 patients of median age 39 years (34 – 47) were included, of which 9 met only the 1990 ACR criteria (100% females), 30 met only 2016 ACR criteria (86% females) and 59 met both criteria (89% females). Widespread Pain index was significantly higher in the 1990 + 2016 group compared to subgroups which met only either of the criteria. Hypothyroidism (subclinical or clinical) was similarly higher in the 1990 + 2016 subgroup. At least one psychological comorbidity was seen in 41%, with CFS present in 30% and PTSD in 14%. The median systolic blood pressure was in the hypertensive range (146 mm Hg) in the 1990-only group, with hypertension being present in 1/3 rd of the total cohort. Obesity was present in 59% and Diabetes in 11%. Iron deficiency anemia was seen in 20%. Table 1. Prevalence of comorbidities in different subgroups of Fibromyalgia Clinical features FMS Cohort ACR 1990 ACR 1990 + 2016 (N-59 ) ACR 2016 p-value (N-98 ) (N-9 ) (N-30 ) F:M 88:10 9:0 53:6 26:4 0.6 Age (years) 39 (34 – 47 ) 38 (32 – 46) 38 (34 – 45) 44 (35 – 50) 0.2 Duration of symptoms (months) 48 (24 – 84 ) 48 (36 – 84) 48 (24 – 78) 60 (27 – 84) 0.6 WPI 15 (12 – 17 ) 14 (8 – 15) 16 (14 – 18) 13 (10 – 16) 0.001 SSS 8 (6 – 10 ) 3 (1 – 4) 6 (7 – 10) 8 (6 – 9) &lt;0.000 TP 13 (9-16 ) 13 (12 – 15) 15 (13 – 16.5) 6 (4 – 8) &lt;0.000 BMI (kg/m2) 26 (23 – 28 ) 23 (22 – 25) 26 (24 – 28) 26 (23 – 29) 0.2 Obese (BMI ≥ 25 kg/m2) 58 (59% ) 3 (33%) 37 (62%) 18 (60%) 0.08 Prediabetes (HbA1c 5.7 – 6.5) 21 (21% ) 0 16 (27%) 5 (16%) 0.8 Diabetes (HbA1C ≥6.5) 11 (11% ) 1(11%) 9 (15%) 1 (3%) 0.2 Systolic BP 125(115–143 ) 146 (117–148) 120(114–137) 127(116–143) 0.1 Diastolic BP 80 (76 – 88 ) 80 (76 – 83) 82 (75 - 88) 79 (76 – 88) 0.8 Hypertension (≥140/90 cm) 37 (37% ) 6 (66%) 20 (33%) 11 (36%) 0.2 Hypothyroidism (TSH &gt; 5 mIU/L) 12 (12% ) 0 11 (22%) 1 (3%) 0.04 Iron deficiency anemia (Serum Ferritin &lt; 12 ng/ml) 14 (20%) (n-67 ) 3 (42%) 9 (23%) 2 (9%) 0.1 OSA (intermediate to high risk by STOPBANG questionnaire) 32 (32% ) 1 (11%) 17 (28%) 14 0.1 CFS 30 (30% ) 1 (11%) 22 (37%) 7 (23%) 0.1 PTSD 14 (14% ) 0 11 (18%) 3 (10%) 0.2 RLS 9 (9% ) 0 5 (8%) 4 (13%) 0.4 F female, M male, WPI widespread pain index, SSS symptoms severity score, TP tender points, BMI body mass index, BP blood pressure, OSA obstructive sleep apnoea, CFS chronic fatigue syndrome, PTSD post traumatic stress disorder, RLS restless leg syndrome Figure 1. Venn Diagram depicting Fibromyalgia subgroups having psychological comorbidities Conclusion There is a high prevalence of comorbidities in patients with fibromyalgia with nearly half having atleast one psychological comorbidity, and obesity, hypertension and iron deficiency anaemia being the common medical comorbidities. Those who met only the 1990 ACR criteria formed less than 10%. References [1]Ahmed S, Aggarwal A, Lawrence A. Performance of the American College of Rheumatology 2016 criteria for fibromyalgia in a referral care setting. Rheumatol Int. 2019 Aug;39(8):1397-1403. [2]Wolfe F, Ablin J, Guymer EK, Littlejohn GO, Rasker JJ. The Relation of Physical Comorbidity and Multimorbidity to Fibromyalgia, Widespread Pain, and Fibromyalgia-related Variables. J Rheumatol. 2020 Apr;47(4):624-631. Disclosure of Interests None declared